tbuckley/cabot-search huggingface dataset:
Abstract 15134: Joint Associations of Fatty Acids With Inflammation and Lipid Profiles: A Mixture Analysis Approach
Authors: Daniel W Riggs, Hong Gao, Clara G Sears, Katlyn E McGraw, Aruni Bhatnagar, Jason Hellmann
Journal: Circulation (2022)

Introduction: The human diet consists of a complex mixture of fatty acids with differential effects on cardiovascular health. Saturated fatty acids have been shown to exert a hypercholesterolemic effect, while omega-3 polyunsaturated fatty acids have anti-inflammatory properties. Advanced statistical approaches are needed however to address whether their covarying relationships may contribute to varying outcomes on cardiovascular health. Methods: We used data on adult participants from the 2003-2004 and 2011-2012 National Health and Nutrition Examination Survey. Blood lipid levels were measured in 2,926 participants, and C-reactive protein (CRP) was measured in 1,339 participants. Fatty acids were measured in serum or plasma and analyzed as the percentage of total fatty acids. We used covariate-adjusted quantile g-computation to assess the joint effects of 6 saturated, 6 monounsaturated, and 11 polyunsaturated fatty acids on log-transformed outcomes, as well as examine the relative contribution of each fatty acid to the joint mixture effect. Results: We estimated positive associations between the mixture of saturated fatty acids with total cholesterol and LDL, which was primarily driven by myristic acid and docosanoic acid. The mixture of monounsaturated fatty acids was associated with lower total cholesterol and LDL, but higher CRP with a quartile increase in monounsaturated fatty acids associated with 21.1% (95% CI: 7.9, 35.9) higher CRP. The mixture of omega-6 polyunsaturated fatty acids was positively associated with both total cholesterol and LDL. We found that the mixture of omega-3 polyunsaturated fatty acids was negatively associated with CRP and LDL. A quartile increase in omega-3 fatty acids was associated with -11.6% (95% CI: -18.8, -3.7) lower CRP, and -2.1% (95% CI: -3.6, -0.4) lower LDL. The relationship with CRP was primarily driven by docosapentaenoic n-3 acid and eicosapentaenoic acid, while the relationship with LDL was driven by docosapentaenoic n-3 acid and docosahexaenoic acid. Conclusions: Assessing the complex mixture of fatty acids, we found distinct beneficial relationships between omega-3 fatty acids with inflammation and lipid profiles, with an important role of docosapentaenoic n-3 acid.
Abstract 15154: Association of Social Isolation/Lack of Social Network With Stroke: A Systematic Review and Meta-Analysis of Prospective Studies
Authors: Rupak Desai, Avilash Mondal, OLUFEMI ODUGBEMI, lakshmi Spurthi Kodali, Sirisha K Gara, Sahana Devakumar, Sahas Reddy Jitta, Naga Amrutha Sai Yalla, Fnu Juveria, Aobo Li, Zarna Bambhroliya, Ankit Vyas
Journal: Circulation (2022)

Background: Social isolation (SI) or loneliness affects overall morbidity, but its influence as a cerebrovascular risk factor is understudied. This review aims to assess the long-term impact of social isolation on stroke risk. Methods: PUBMED, Scopus, and EMBASE were systematically searched for prospective studies reporting stroke/cerebrovascular outcomes of lack of social contact/network or SI. A stroke/systemic embolic event was the primary endpoint. Pooled relative risk and heterogeneity were assessed with random-effects models and I 2 statistics, respectively. Subgroup analysis was performed based on follow-up duration and mean/median age of patients. Leave one out sensitivity analysis was performed. A funnel plot was used for visual assessment of publication bias. A p&lt;0.05 was considered a threshold for statistical significance. Results: A total of 9 prospective studies were included between 2006 and 2021(N=177,591, mean age: 53- 67 years) reporting patients with a lack of social support/network or, SI. 5 studies from the US and rest from other high-income countries. A total of 5657(3.3%) stroke events were recorded in a median follow-up duration of 10.25 years. Pooled analysis revealed a higher odds of stroke in SI vs non-SI cohorts on adjusted (OR 1.37 95%CI 1.13-1.65, p= 0.01) analysis [Fig. 1] . Subgroup analysis indicated a higher risk of stroke in studies with a follow-up duration of &lt;10 years vs &gt;10 years (1.47 vs 1.20, p=0.01) [Fig. 2] and in studies with more elderly participants [mean/median ≥60 years vs &lt;60 years (1.45 vs 1.22, p&lt;0.001)] [Fig. 3] . Conclusions: Our findings suggest that lack of social contact/network or social isolation is associated with an increased risk of developing stroke over a median follow-up of a decade, especially in older individuals. Future studies are needed to investigate whether interventions targeting social isolation can help to prevent one of the leading causes of death and disability in high-income countries.
Abstract 15172: Improving Cardiac Segmentation for Atrial Fibrillation Ablation: A Prospective Trial of Machine Learned Geometric Dissection vs Experts
Authors: Ruibin Feng, Brototo Deb, Prasanth Ganesan, Fleur V Tjong, Samuel Ruiperez-Campillo, Paul L Clopton, Albert J Rogers, Sulaiman Somani, Miguel Rodrigo, James Zou, Matei Zaharia, Sanjiv M Narayan
Journal: Circulation (2022)

Introduction: Segmenting cardiac computed tomography (CT) to provide anatomic guidance for Atrial Fibrillation (AF) ablation is routinely applied, but is time-consuming and prone to error. Machine learning (ML) is a powerful approach that could automate this approach, but is hindered by the small size of available labeled datasets. Hypothesis: We hypothesized that a new computational pipeline, in which an ML model is trained mathematically in a small cohort (N=20) using geometrical heart avatars derived from computer graphics imaging (CGI), rather than on manually-segmented data, would enable rapid expert-level segmentation of raw cardiac CT scans. Methods: We first encoded anatomical knowledge with generic geometrical avatars and derived a “virtual dissection” method to geometrically parse the heart (Fig A). An ML model trained by virtual dissection using 20 cases was able to rapidly and accurately segment the pulmonary veins (PVs), left atrial appendage (LAA), and left atrium (LA) from cardiac CT scans (Fig B), which we tested in a retrospective study of N=100 patients (30% women, 64.7±10.1Y) and in a prospective clinical trial of N=42 patients (42.9% women, 65.2±10.8Y) undergoing AF ablation, against a panel of 3 experts (Fig C). Results: In a retrospective study (N=100), ML achieved median Dice scores of 96.6% (IQR: 95.1% to 97.5%), similar to experts (p&lt;0.05). In a prospective study (N=42), this pipeline reduced segmentation time (2.3±0.8 vs 15.0±6.9 minutes; p &lt; 0.00001; Fig D), but achieved similar Dice scores (93.9% (IQR: 93.0% to 94.6%) vs 94.4% (IQR: 92.8% to 95.7%); p&lt;0.05; Fig E). Conclusions: In our prospective trial, virtual dissection (machine learning of cardiac structures based on mathematical cardiac geometry) accelerated cardiac segmentation prior to AF ablation. In general, this approach may reduce the dependence on large training datasets for machine learning, and could be applied to other organ systems for diverse therapeutic strategies.
Evaluation of the Effectiveness of Remote Foot Temperature Monitoring for Prevention of Amputation in a Large Integrated Health Care System
Authors: Alyson J. Littman, Andrew K. Timmons, Anna Korpak, K.C. Gary Chan, Kenneth T. Jones, Suzanne Shirley, Kyle Nordrum, Jeffrey Robbins, Suhail Masadeh, Ernest Moy
Journal: Diabetes Care (2023)

OBJECTIVE We evaluated the effectiveness of remote foot temperature monitoring (RTM) in the Veterans Affairs health care system. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study that included 924 eligible patients enrolled in RTM between 2019 and 2021 who were matched up to 3:1 to 2,757 nonenrolled comparison patients. We used conditional Cox regression to estimate adjusted cause-specific hazard ratios (aHRs) and corresponding 95% CIs for lower-extremity amputation (LEA) as the primary outcome and all-cause hospitalization and death as secondary outcomes. RESULTS RTM was not associated with LEA incidence (aHR 0.92, 95% CI 0.62–1.37) or all-cause hospitalization (aHR 0.97, 95% CI 0.82–1.14) but was inversely associated (reduced risk) with death (aHR 0.63, 95% CI 0.49–0.82). CONCLUSIONS This study does not provide support that RTM reduces the risk of LEA or all-cause hospitalization in individuals with a history of diabetic foot ulcer. Randomized controlled trials can overcome important limitations.
Abstract 150: Left-digit Bias In Out-hospital Cardiac Arrest - JCS ReSS
Authors: TAKAHIRO SUZUKI, Atsushi Mizuno, Daisuke Yoneoka, Takahiro Nakashima, Tetsuya Matoba, Koichi Node, Naohiro Yonemoto, Yoshio Tahara, Yoshio Kobayashi, Takanori Ikeda
Journal: Circulation (2022)

Introduction: Left-digit bias, a cognitive bias, has been linked to medical errors in clinical decision-making. Although the impact of left-digit bias on outcome and behavior has previously been examined in the setting of in-hospital cardiac arrest, that in the setting of our-of-hospital cardiac arrest has not been fully evaluated. In the current study, we investigated the impact of left-digit bias on resuscitators’ behavior during out-of-hospital cardiac arrest (OHCA). Methods: The All-Japan Utstein Registry of the Fire and Disaster Management Agency is a nationwide, prospective, population-based OHCA registration system in the Utstein format. We retrospectively included all consecutive OHCA patients within three years below and above the age of 80 witnessed by family members from January 1, 2005, to December 31, 2020. The primary endpoints were the percentage of bystander-initiated cardiopulmonary resuscitation (BCPR) performed by family members or EMS and the percentage of prehospital physician-staffed advanced cardiac life support (ACLS). We compared the percentages of resuscitation performed by family members, emergency medical services (EMS), and physicians, by using a regression discontinuity methodology to evaluate if there was a dramatic change in the percentage of BCPR and ACLS performed rate at the age threshold of 80 years, which would imply left-digit bias. Results: Of total 1,930,273 cases of OHCA in the All-Japan Utstein registry, we enrolled total of 92,674 (4.8%) patients. The mean age of the population was 80.1 years; 61284 (66.1%) patients were men. There were 37,903 (40.9%) patients between the ages of 77 and 80, and 54,771 (59.1%) patients between the ages of 80 and 83. In this model, we identified no discontinuities in the level (risk difference, -0.50%; 95%CI -1.35% to 0.36%, 0.27%; 95%CI -0.29% to 0.84%, 0.68%; 95%CI -0.29% to 1.66%) for the percentage of BCPR by family members and EMS, and physicians’ ACLS, respectively. Conclusions: In conclusion, our findings did not imply that age-related cognitive bias affected the resuscitators’ behavior during out-of-hospital cardiac arrest.
Abstract 15100: Relationship Between Obstructive Sleep Apnea and Acute Coronary Syndrome: A Cross-Sectional Study
Authors: Zakaria Alagha, Muhammad Ghallab, Mahmoud Nassar, Yasser Yazied, Maha Alastal, Salma Aabdelmoteleb, Hossam Kandil, Kareem Mahmoud
Journal: Circulation (2022)

Introduction: Obstructive sleep apnea (OSA) is a common and underestimated chronic condition recognized as a risk factor for cardiovascular diseases. OSA and acute coronary syndrome (ACS) have been reported in several cases. This study aims to assess the prevalence of the OSA among patients with ACS. Hypothesis: We hypothesize that there is a correlation between OSA and ACS. Methods: This study is a cross-sectional, descriptive study that included 110 patients with ACS at the Cairo University Hospitals in Egypt between December 2018 and July 2019. We included patients diagnosed with ACS over the age of 40. We excluded patients who had disturbed consciousness levels, were intubated/mechanically ventilated, were on psychiatric medications, or used drugs. Furthermore, we excluded individuals with CKD or liver disease. We collected patients’ demographic characteristics, and chronic medical conditions, and performed a sleep assessment. Every patient had a detailed workup for ACS. We assessed OSA based on the STOP-BANG score. The significance of baseline and clinical characteristics, laboratory and imaging findings, and the severity of ACS and its outcome were studied. Results: The mean age of the patients was 58.2±9.6. The majority of patients were male (74.5%). 70.9% of the patients had metabolic syndrome. The mean body mass index was 28.6±4.8; the majority of patients presented with STEMI (60.9%), while only 26.4% and 12.7% presented with NSTEMI and unstable angina respectively. The prevalence of OSA among ACS patients was 63.6%, and of them, 55.7% presented with STEMI, while only 32.9% and 11.4% presented with NSTEMI and unstable angina respectively. Also, the study revealed a statistically significant relationship between OSA and NSTEMI patients (OR: 2.77 [95% CI 1.02-7.55], p=0.041), while there was no statistically significant relationship between OSA and unstable angina patients (OR: 0.73 [95% CI 0.2-2.3], p=0.579) and between OSA and STEMI patients (OR: 0.54 [95% CI 0.2-1.2], p=0.14). Conclusion: To the best of our knowledge, this is the first study to study the prevalence of OSA in ACS patients in the region of Africa. The study indicated a high prevalence of OSA among ACS patients, with a more significant correlation between OSA and NSTEMI patients.
Abstract 15011: Deriving and Validating Novel Neighborhood Data for Investigation of Adverse Outcomes in Patients Hospitalized for Heart Failure: A Feasibility Study
Authors: Juhao Zhang, Samantha Lin, Yunjie Wu, Jing Zhang, Alanna A Morris, Shivani A Patel, Joyce C Ho
Journal: Circulation (2022)

Introduction: Census-based measures of population-level neighborhood deprivation have been linked to adverse outcomes in patients with heart failure (HF). However, limited data exist to examine the impact of neighborhood environmental characteristics on HF outcomes. Objective: Derive novel measures of the patient built environment using multiple databases and compare their performance with traditional Census-based measure of population deprivation to predict 30-day readmission following hospitalization with HF. Methods: We identified the 17 census tracts in the metropolitan Atlanta area from the lowest, middle, and highest tertiles of the Social Deprivation Index (SDI), a neighborhood deprivation measure derived from US Census data. Three novel data sources—Twitter, Foursquare, and Google Places—were used to compute 6 environmental scores in each census tract: accessibility to parks, pharmacies, grocery stores, restaurants, sports places (e.g., gyms and fields), and health facilities (e.g., clinics and hospitals). We computed Pearson correlations across the data sources. We examined model performance of the 6 environmental scores and the SDI to predict readmissions in 804 patients (mean age 67 y, 52% female, 77% Black) hospitalized for acute HF at Emory Healthcare in 2018 using logistic regression adjusted for patient demographic and clinical characteristics. Results: Correlations across data sources ranged from r =-.45 to .65 (Figure 1a). Compared with SDI, 4 of the 6 environmental measures yielded marginally higher AUC values (discrimination) and 2 yielded higher pseudo R-squared values (calibration) for 30-day readmission (Figure 1b). Conclusion: This study demonstrates the early feasibility of directly measuring the patient built environment using novel data streams, and shows that these data may enhance neighborhood understanding of HF outcomes. Future studies should focus on scaling beyond the metropolitan Atlanta area.
Abstract 15087: Chronic Inhibition of NADPH Oxidase Improves Coronary Endothelial Function in Mice With Diabetes
Authors: Lina Wang, Yi Song, Zhiqi Zhang, Jun Feng
Journal: Circulation (2022)

Introduction:: Endothelial dysfunction is the leading cause for diabetes (DM) related coronary heart disease. Diabetes is associated with NADPH Oxidase (Nox) overproduction and related ROS amplification in endothelial cells and coronary vasculature, which may contribute to coronary endothelial dysfunction. Small conductance calcium-activated-potassium (SK) channels also play a key role in diabetes-induced coronary endothelial dysfunction . Hypothesis: Chronic inhibition of Nox may improve coronary endothelial function/coronary arteriolar relaxation, and SK activator-induced vasodilation in mice with or without diabetes. Methods: Wild type (control), non-diabetic (ND) mice and genetically modified, obesity/type-2 diabetic mice (BKS.Cg- Dock7 m +/+ Lepr db /J) with or with treatment with Nox inhibitor apocynin (n = 4-6/group) were used in the study. In the Nox inhibitor treated group, apocynin (30mg/kg/day, i.p) was applied to the diabetic mice for 4 weeks. Small coronary arteries (70-120μM) isolated for harvested hearts were pre-contracted and examined in the presence or absence of the vasodilatory agents, SNP, ADP, and NS309, respectively. Results: After 4-week treatment with apocynin, endothelium-NO-dependent relaxation responses to ADP, and endothelium-dependent, SK channel activator NS309 in the diabetic mice were significantly increased when compared with that in untreated diabetic mice, respectively (# p&lt;0.05 vs ND Figure ). There were no significant differences in responses to the endothelium-independent vasodilator SNP (P&gt;0.05) among the three groups. Conclusions: Chronic inhibition of Nox appears to improve coronary endothelial function/coronary relaxation and SK channel activity in mice with diabetes.
Abstract 14967: Rate of Growth of the Right Ventricular Outflow Tract in Repaired Tetralogy of Fallot: A Cardiovascular Magnetic Resonance Imaging Study
Authors: Kelsey J Jurow, Kimberlee Gauvreau, Nicola Maschietto, Ashwin Prakash
Journal: Circulation (2022)

Introduction: Patients with repaired tetralogy of Fallot (rTOF) often require pulmonary valve replacement (PVR). Transcatheter PVR is a less invasive alternative to surgery but many right ventricular outflow tracts (RVOTs) are too large. Understanding the rate of RVOT growth may help optimize timing of referral. This study examined the growth of the RVOT over time in rTOF. Methods: We retrospectively analyzed serial cardiac MRI (CMR) data from 121 patients with TOF (median 3 MRIs per patient; range 2 to 10) to calculate the rate of increase in perimeter-derived diameters of the proximal infundibulum, middle RVOT, and distal RVOT at the point of PA bifurcation (Figure 1). The median age at first CMR was 14.7 years (range 3.3, 43.6 years) with a mean interval between first and last CMR of 8 years ± 3 years. Results: All parameters increased over time. The proximal RVOT increased at a rate of 4.1 mm per 10 years (p &lt; 0.001); the mid and distal RVOT both increased at a rate of 3.1 mm per 10 years (p &lt; 0.001) (Figure 2). The RVOT was larger on average in patients with a higher RV end diastolic volume (RVEDV) at first MRI and in patients with a higher pulmonary regurgitation (PR) fraction at first MRI. Patients with greater increases in RV EDV (Spearman correlation 0.48, p &lt; 0.001) or PR fraction (Spearman correlation 0.27, p = 0.003) over time had greater RVOT growth. Conclusions: This largest-to-date serial CMR study of patients with rTOF detailed the rate of growth of the RVOT over time. More rapid growth was associated with higher PR fraction and larger RVEDV. This data may be useful in the design and clinical use of transcatheter pulmonary valves.
Abstract 14966: Mechanisms of Protection From Radiation-Induced Endothelial Injury by Statins
Authors: Karima Ait-Aissa, Olha Koval, Nathanial Lindsey, Linette Leng, Isabella M Grumbach
Journal: Circulation (2022)

Introduction: The incidental use of statins during radiation therapy has been associated with a decreased risk of long-term atherosclerotic cardiovascular (CV) disease. However, the mechanisms by which statins protect the vasculature from irradiation injury remain poorly understood. Hypothesis: Establish the mechanisms by which lipophilic and hydrophilic statins preserve endothelial function after irradiation. Methods: Cultured human coronary and umbilical vein endothelial cells irradiated with 4 Gy and mice on day 1 and 10 after head and neck irradiation with 12 Gy were assessed for endothelial dysfunction, nitric oxide and reactive oxidative stress production and various mitochondrial phenotypes. Results: Pretreatment of mice with pravastatin or atorvastatin prevented the loss of endothelium-dependent relaxation on day 1 and 10 after head and neck irradiation. Both statins inhibit the loss of nitric oxide, and the increase in cytosolic reactive oxidative stress in endothelial cells. However, only pravastatin blocked mitochondrial superoxide production, mitochondrial DNA damage and loss of electron complex activity. In contrast to atorvastatin, pravastatin also significantly reduced the expression of inflammatory markers TNF-α, NFκB p65 and p50 after irradiation. Conclusions: Our findings provide mechanistic underpinnings for the vasoprotective effects of statins after irradiation. While lipo- and hydrophilic statins shield from endothelial dysfunction after irradiation, pravastatin also prevents mitochondrial injury and decreases an inflammatory response by actions in mitochondria. A correlation with clinical studies is necessary to determine whether hydrophilic statins, such as pravastatin reduce the risk of CV disease after irradiation in humans to a greater extent than lipophilic statins.